Cataract surgery with lens implant
Facility: Aurora Medical Center
Billing Code: 66984 (CPT)
- CPT Billing Code: 66984
- Insurance Median: $3,350
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 1.42x Medicare
Average discount available for prompt cash payment at this facility.
Median negotiated contract rate across all mapped commercial carriers.
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. Medicare
Understanding this gauge: We use the federal Medicare rate of $2,357.81 as the cost baseline. Rates below the baseline represent excellent value. In-network commercial rates commonly hover around 150% - 250% of Medicare, while rates exceeding 300% are elevated. Hover over the green and blue markers to view detailed calculations.
Out-of-Pocket Cost Estimator
Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.
Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Everpointe Elite | $2,789 | 118% |
| Aetna | $3,008 | 128% |
| UnitedHealthcare | $3,057 - $3,353 | 130% |
| Molina Exchange | $3,066 | 130% |
| Common Ground | $3,085 | 131% |
| Centivo | $3,115 | 132% |
| Aurora Caregiver | $3,200 | 136% |
| Quartz One | $3,350 | 142% |
| Health Payment Systems | $3,400 | 144% |
| Wisconsin Physician Service | $3,791 - $3,914 | 161% |
| Quartz Group | $3,920 | 166% |
| Hs Technology | $3,939 | 167% |
| Trilogy | $4,212 | 179% |
| Blue Cross Blue Shield | $11,302 - $14,586 | 479% |
| Cigna | $17,500 | 742% |
Consumer Guidance & Cost Commentary
For this Cataract surgery with lens implant at Aurora Medical Center in Grafton, WI, the median negotiated rate is $3,350. This facility is a voluntary non-profit acute care hospital located at 975 Port Washington Road. While specific cash and state/county average data points are not provided in this report, patients should note that cash-pay options can sometimes result in lower out-of-pocket costs than insurance negotiated rates, particularly for those with high-deductible plans where the insurance allowed amount might exceed the cash price. It is recommended to contact the hospital directly to inquire about self-pay or prompt-pay discounts before scheduling, as these upfront fee reductions can significantly lower the total cost.
The Medicare benchmark amount for this procedure is $2,357.81, which serves as a cost-based baseline for evaluating the facility's pricing. The commercial negotiated rates range from a low of $2,789 with Everpointe Elite to a high of $17,500 with Cigna, with UnitedHealthcare showing a range of $3,057 to $3,353 across four plans. Because commercial negotiated rates often include administrative overhead and contract dynamics that can inflate prices to 200% to 300% of Medicare levels, patients should verify their specific plan's allowed amount. If a patient receives a bill exceeding their insurance allowed amount, they may be subject to balance billing, though the No Surprises Act provides protections against unexpected out-of-network charges at in-network facilities. Consumers are advised to request a full itemized CPT-coded bill to identify any errors, unbundled codes, or services not rendered, as over 80% of hospital